May 2024
169 ArticlesNo Section
Exploring the Landscape of Familial Hypercholesterolemia: Unraveling Genetic Complexity and Clinical Implications
Familial hypercholesterolaemia (FH) is the most encountered inherited metabolic disorder and is associated with premature cardiovascular disease.[1] Although early diagnosis is imperative for... more
Clinical Insights
Metabolic dysfunction-associated steatotic liver disease: Evolution of the final terminology
The liver is affected by metabolic dysfunction, featuring variable degrees of steatosis, inflammation, liver cell injury, and fibrosis. Since alcohol can cause similar changes in the liver, this... more
Clopidogrel induced reduction in neutrophil count: An overlooked beneficial effect?
Atherosclerosis is an inflammatory disease of the arteries with endothelial dysfunction favouring leukocytes recruitment into the arterial wall and ensuing lesion growth. The role of neutrophils has... more
Monkeypox infection, 18 months later: A vanishing epidemic?
On July 25, 2022, the World Health Organization (WHO) declared the Monkeypox (MPX) outbreak a ‘public health emergency of international concern’. Indeed, starting from May 2022, 92,783 cases have... more
Detection of subclinical atrial fibrillation with cardiac implanted electronic devices: What decision making on anticoagulation after the NOAH and ARTESiA trials?
Atrial fibrillation (AF) may be asymptomatic and the extensive monitoring capabilities of cardiac implantable electronic devices (CIEDs) revealed asymptomatic atrial tachi-arrhythmias of short... more
The lowest well tolerated blood pressure: A personalized target for all?
Among the various clinical aspects related to the management of hypertension, the choice of blood pressure (BP) targets is probably one of the most challenging. Unfortunately, there is disagreement... more
Commentary
Use simple tools to improve complex conditions
"Medicine is both an art and a science; the art of listening, the art of understanding, and the art of predicting." (Hippocrates)
Low-dose colchicine for chronic stable atherosclerosis: Under-appreciated and under-prescribed
In June of 2023, the United States Food and Drug Administration (FDA) approved the use of low dose colchicine as the first anti-inflammatory drug to treat atherosclerotic disease. Specifically, “... more
The optimal management of arterial blood pressure in acute stroke: A never-ending conundrum
Our understanding of the influence of blood pressure (BP) on the development of acute ischemic stroke and its significance in preventing further occurrences has prompted numerous researchers to... more
Artificial intelligence supported ultrasonography: Can it be the solution for early and accurate diagnosis of steatotic liver disease?
Last December, a multi-society Delphi consensus reported on the new nomenclature and definitions of fatty liver disease [1]. Accordingly, the previous terms of non-alcoholic fatty liver disease (... more
Obesity phenotyping at the “heart” of risk stratification
The recognition of obesity as a chronic disease is increasingly gaining consensus within the scientific community, supported by mounting evidence of its significant impact on overall morbidity and... more
Pulmonary embolism: Put the sPESI into practice
Since acute pulmonary embolism (PE) remains one of the leading causes of cardiovascular morbidity and mortality, the increased attention to risk prediction is well deserved [1]. Timely and accurate... more
When to prescribe oral anticoagulation for patients with device-detected subclinical atrial fibrillation? Insights from the NOAH-AFNET 6 and ARTESiA trials
Device-detected, subclinical atrial fibrillation (AF), previously known as atrial high-rate episodes, is detected in roughly one-third of older patients with a pacemaker, defibrillator, or implanted... more
Subclinical atrial fibrillation patients, who are the best candidates for oral anticoagulant therapy?
Conventionally, atrial fibrillation (AF) is diagnosed by surface electrocardiogram (ECG) while cardiac implantable electronic devices (CIEDs) provides information of the cardiac electrical activity... more
Estimation of renal function: Different markers for different outcomes?
Sarcopenia is a condition characterized by loss of muscle strength and mass that is strongly associated with age and age-related conditions, and is therefore considered a typically geriatric disease... more
Direct oral anticoagulants: The new standard of care for cancer associated thrombosis
Venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), often complicates the course of cancer disease and represents an invariably distressing experience for... more
Action points for implementation of the lowest well-tolerated blood pressure
In a seminal review of hypertension trials [1], Verdecchia and coworkers noticed that more intensive compared to usual blood pressure (BP) control reduced major cardiovascular complications (MACE),... more
Combining electrocardiographic and echocardiographic indexes to detect cardiac amyloidosis: A step forward in the quest to diagnose cardiac amyloidosis without delay
Cardiac amyloidosis (CA) is a progressive and life-threatening cardiomyopathy characterized by deposition of misfolded proteins in the myocardium, leading to heart failure (HF), conduction disorders... more
A call to action: The need to apply guidelines recommendations with ABC or SOS to improve stroke prevention and cardiovascular outcomes in patients with atrial fibrillation
Atrial fibrillation (AF) and stroke are deeply interlinked, as AF may precede ischemic stroke, thus being related to cardioembolism, but also manifest after both ischemic and hemorrhagic stroke [1].
Uncomplicated outpatient deep venous thrombosis management with a novel care pathway: Is it ready for prime time?
The standard-of-care for patients presenting to a general practitioner (GP) with suspected deep vein thrombosis (DVT) in many regions involves the use of a clinical decision rule and/or a d-dimer... more
Stressful experiences and venous thromboembolism
Despite stress being an accepted cause of arterial thrombotic events (ATE) [1,2], for which underlying pathophysiological processes have also been identified, it has not yet been widely recognised as... more
Editorial
New horizons in the diagnosis and management of patients with MASLD
The collection 'New horizons in the diagnosis and management of patients with metabolic dysfunction-associated steatotic liver disease (MASLD)’ that is presented here, deals with the natural history... more
Guidelines
Acute heart failure – an EFIM guideline critical appraisal and adaptation for internists
Over the past two decades, several studies have been conducted that have tried to answer questions on management of patients with acute heart failure (AHF) in terms of diagnosis and treatment.... more
Ideas and Opinions
What is disease modification and is this concept even helpful?
An interesting session during a major scientific conference attended by the authors in fall 2023 discussed the concept of disease modification (DM). It became evident that DM is something that... more
Is full transparency in clinical trials an achievable goal?
In the last two decades several requirements have been developed to enhance clinical trials transparency. Some are encouraged or recommended by ethics codes, journal editors, or funders. Others are... more
Internal Medicine Flashcard
A man with darkened neck
A 65-year-old man presented with a 12-month history of gradual darkening of his neck. He also reported a progressive increased right side mandibular mass and a weight loss of 4 kg over 3 months. He... more
Gram staining of shoulder joint fluid
An 88-year-old Japanese man with Alzheimer's disease presented with fever that lasted for 1 day and arthralgia in the left shoulder. The patient had no history of trauma. On physical examination, his... more
Difficult to treat rheumatoid arthritis: Why profound differential diagnosis is important
A 47-year-old patient was referred to our rheumatology department due to treatment refractory rheumatoid arthritis, characterized by polyarthralgia, progressive joint destruction, and impaired... more
A man with neurologic symptoms during liver abscess treatment
An 84-year-old man was admitted for a pyogenic liver abscess and was treated with intravenous ceftriaxone and oral metronidazole 500 mg three times per day. The treatment proved effective; however,... more
A young man with amnesia after drug overdose
A 29-year-old man was found unconscious on the side of the road. Examination revealed pinpoint pupils and bradypnea. He regained consciousness after intranasal naloxone.
Pruritic papules and reticular pigmentation
A 21-year-old male with a previous history of good health. One month earlier, scattered, pruritic, red papules and maculopapules had developed on the chest and back. After papules fades, left light... more
Beau‘s lines in a man with lower limb burning sensation
A 49-year-old man presented with several months of burning sensation and numbness in the lower extremities. According to his statement of the medical history, there were no excessive drinking, intake... more
Internal Medicine Flashcards
An unexpected detour: Acute throat pain and trismus in a fast-food deliveryman
A 40-year-old man fast-food deliveryman presented to the emergency department with a severe sore throat and trismus. His-symptoms rapidly escalated over 24 h, impairing his ability to speak, eat, and... more
Invited Review Article
Management of cardiovascular risk in patients with metabolic dysfunction-associated steatotic liver disease
Non-alcoholic fatty liver disease (NAFLD) has for years been the most common liver disease worldwide. In 2016, the prevalence of NAFLD was estimated to be approximately 25 % [1], and recent reports... more
Letter to the Editor
Stenting improves cardiovascular clinical outcomes in patients with middle aortic syndrome caused by aortoarteritis: Long-term results
Takayasu arteritis (TA), also known as aortoarteritis, often involves the middle aorta and manifests as middle aortic syndrome (MAS) [1]. Owing to persistent and severe hypertension attributed to... more
Self-publishing in the history of medicine: The paradoxical case of Edward Jenner's science-changing monograph (1798)
According to the Cambridge Dictionary, self-publishing is regarded as the act of arranging or paying for one's ‘own book to be published, rather than having it done by a publisher’ [1]. Whether it be... more
Nitrous oxide toxicity in adult patients with sickle cell disease
Sickle cell disease (SCD) is an inherited autosomal recessive disorder that confers atypical haemoglobin called haemoglobin S, which can distort red blood cells in sickle-shaped cells and modifies... more
Kidney function and sarcopenia: A risk assessment. Author's reply
To the Editor
Environmental costs of noninvasive cardiac testing for acute chest pain after ED discharge
Acute chest pain (ACP) accounts for more than 7 million Emergency Department (ED) visits each year in the US [1]. Patient management initially relies on the estimated risk of short term... more
Monkeypox: A risk factor for inflammatory diseases?
I read with interest the article by Patauner and colleagues [1]. Even though most cases have a full recovery without significant sequelae, little is known about the mid- and long-term outcome of... more
The new nomenclature SLD and categories provided better classification for elderly Chinese with liver steatosis
We were inspired by the recent article by van Erpecum and Dalekos [1], which proposed new horizons in the diagnosis and management of patients with metabolic dysfunction-associated steatotic liver... more
Prevalence and outcome of occult giant cell arteritis
Giant cell arteritis (GCA) is a large vessel vasculitis that preferentially affects the cranial arteries and the aorta and its proximal branches [1]. Presenting features of GCA may include symptoms... more
Early intervention is important when administering glucarpidase for methotrexate intoxication. Author's reply
Bettini and Rizzari recently responded with precision [1] to a letter our group sent to the European Journal of Internal Medicine regarding the possible benefits of administering the antidote... more
Use of direct oral anticoagulants in patients with left ventricular thrombus
Left ventricular thrombus (LVT), one of the most feared and common complications of acute myocardial infarction (AMI), still causes morbidity and mortality in a proportion of patients despite the... more
Short-term trends in gastric cancer incidence after insurance coverage expansion for Helicobacter pylori eradication in Japan
Helicobacter pylori (H. pylori) infection is a risk factor for gastric cancer (GC). The International Agency for Research on Cancer has recommended population-based screening and eradication of H.... more
Synergistic effect of spironolactone/ARB on cardiovascular endpoints in heart failure patients with preserved ejection
Currently, treatment options for HFpEF are limited. Several randomized controlled trials of RAAS inhibitors for HFpEF, including perindopril, candesartan, irbesartan, and spironolactone, have yielded... more
Effect of direct oral anticoagulants in patients with cerebral venous thrombosis
Cerebral venous thrombosis (CVT) is a rare clotting disorder that mainly affects younger females. In order to achieve recanalization of cerebral veins and reduce the risk of venous thromboembolism (... more
‘Impact of Haemophilus spp. as a sexually transmitted disease’
Despite the increasing prevalence of Haemophilus spp. isolates in urethral exudates in our health area, a city with more than 160,000 inhabitants in the south of Madrid, there are still uncertainties... more
The clinical spectrum of thymoma-associated immunodeficiency: Good syndrome and beyond
Good syndrome (GS) is an acquired adult-onset combined immunodeficiency typically characterized by thymoma and hypogammaglobulinemia. Other clinical manifestations include recurrent infections,... more
Interaction between age and efficacy of dual antiplatelet therapy in non-cardioembolic minor acute ischemic stroke or high-risk transient ischemic attack
Short-term (21–90 days) dual antiplatelet therapy (DAPT) with aspirin plus clopidogrel is recommended for patients with minor non-cardioembolic ischemic stroke [National Institutes of Health Stroke... more
Infective endocarditis complicated with heart failure
Infective Endocarditis (IE) is a clinical entity with high morbidity and mortality despite advances in diagnosis and medical and surgical treatment alternatives. Globally, the prevalence is estimated... more
Resuming antiplatelet therapy in patients with intracranial hemorrhage
More than a third of adults who experience primary intracranial hemorrhage (ICH) in high-income countries are prescribed antiplatelet medications due to similar risk factors shared with vascular... more
Polyvalent immunoglobulin use: Issues between good use, economic constraints and shortages over 25 years
Human normal polyvalent immunoglobulins (HNIg) have been widely used for the treatment of primary and secondary immune deficiencies. They also possess immunomodulatory properties and are employed in... more
A prediction model for differentiating recurrent Kawasaki disease from other febrile illnesses
Kawasaki disease (KD) can result in coronary artery aneurysms (CAA), elevating the risk of coronary artery thrombosis in the later stage [1]. Intravenous immunoglobulin within the first 10 days after... more
Long-term compliance of lipoprotein apheresis patients. What is health-related quality of life?
Clinical research and scientific evidence confirm the role of low-density lipoprotein cholesterol (LDL-C) and lipoprotein (a) [Lp(a)] as a risk factor for atherosclerosis and cardiovascular events.... more
Diagnosis traps for patients with acquired NLRP3 mutation
Cryopyrinopathies (cryopyrin-associated periodic syndrome, CAPS), also referred to as NLRP3 mutation-associated autoinflammatory diseases (NLRP3-AID), have historically been described as three... more
Antibiotic shortages in Europe: Another question of prices?
Pharmaceutical shortages are currently a worldwide issue despite advancement in manufacturing and transport technologies [1]. Surprisingly, shortages still happen in many high-income countries too... more
Changes in the Dynamic Trajectory of Remnant Cholesterol Affect the Occurrence of Nonalcoholic Fatty Liver Disease
Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease worldwide, affecting approximately 20–25 % of the global adult population [1]. Epidemiological evidence showed that,... more
Patient-reported outcomes and apixaban therapy in older patients
Dear Editor
Chronic limb-threatening ischemia with no revascularization option: Result from a multidisciplinary care model
Lower extremity chronic limb-threatening ischemia (CLTI) is the most advanced form of peripheral arterial disease (PAD). Historically, development of CLTI was associated with 1-year amputation rates... more
Development and validation of a clinical risk score for all-cause mortality in patients with acquired long QT syndrome
Dear editor,
Bleeding heralding the diagnosis of essential thrombocythemia
We appreciate the opportunity to reply to the Letter to the Editor of Yang et al. [1], which refers to our recent publication [2] in order to present a case with a complementary clinical issue.
Admission in Internal Medicine: The Italian issue
We appreciated the editorial by Garattini et al. [1], about the redesign of the Emergency and Urgency system in Europe. In relation to this argument, we would like to underline some critical aspects... more
Effect of sodium-glucose cotransporter-2 inhibitors on pulmonary arterial wedge pressure
Several recent landmark trials have demonstrated that treatment with sodium–glucose cotransporter 2 inhibitors (SGLT2i) confers significant benefits to patients with heart failure (HF) and/or type 2... more
Minimally invasive puncture and drainage guided by 3D printed guide plate for the treatment of primary brain stem hemorrhage
Primary brainstem hemorrhage manifests rapidly and is linked to poor prognosis, boasting a high fatality rate. It is an acute and lethal neurological disorder. With a hemorrhage volume exceeding 5 mL... more
Benefits and challenges of bronchoalveolar lavage in immunocompromised patients
Jahn K et al. conducted a prospective single-center observational study and found that treatment management changed in approximately half of the patients with immunocompromised lower respiratory... more
Impact of the timing of initial antibiotic administration on community-onset pneumonia hospital mortality
Timely administration of appropriate antibiotics (ATB) is critical for treatment success in severe infections [1]. In clinical practice, early ATB administration in pneumonia is a common-sense... more
Machine learning models for the early prediction of ventilator-associated pneumonia: Author's reply
Dear editor,
HbA1c% level patterns as a marker for malignancy in diabetic patients
Tumor-induced hypoglycemia is an uncommon phenomenon, usually resulting from insulin-secreting tumors [1]. However, it can also develop in other tumors, exclusively due to increased glucose... more
Effect of non-vitamin K oral anticoagulants for thrombosis prophylaxis in pediatric heart diseases
Non-vitamin K oral anticoagulants (NOACs, namely dabigatran, rivaroxaban, apixaban, and edoxaban) have been widely recommended in preventing thromboembolic events among adult patients with atrial... more
Association between direct oral anticoagulants and risk of gastrointestinal bleeding
We read with great interest the systematic review and meta-analysis by Kyriakoulis et al. comparing direct oral anticoagulants (DOACs) with vitamin K antagonists (VKAs) in patients with atrial... more
Role of emergency department physician in the management of osteoporotic fragility fractures in the elderly trauma patient
Worldwide, half of females above the age of fifty years and 25 % of males over 65 years will sustain a fracture secondary to osteoporosis during their lifetime, with a refracture rate of 50 % in... more
Patient centered care: A multidisciplinary and holistic approach
Modern medical care is increasingly underpinned by evidence-based guidelines which are widely viewed as a cornerstone of current efforts to define standards of care and improve the quality of... more
Outcomes of initial intravenous diuretic dose in acute heart failure
We would like to share with you the outcomes of our study revolving around the routine use of diuretics in acute heart failure (AHF). The topic is of great interest, and although many studies and... more
The impact of sodium-glucose cotransporter-2 inhibitors on cardiac function
Dear Editor,
Comparing the risk of dementia in patients with atrial fibrillation taking different oral anticoagulants
Dear editor,
Efficacy and safety of eplerenone in heart failure management
Dear Editor,
Safety of apixaban and rivaroxaban in patients with atrial fibrillation on hemodialysis
Dear Editor,
Prevalence of post-COVID symptoms one-year after SARS-CoV-2 infection in patients with interstitial lung disease
The Global Burden of Disease Study revealed that chronic respiratory diseases remain to be leading cause of death and disability worldwide [1]. In the recent years, the world has experienced a... more
MEFV gene mutation (c.229G>T) as a cause of fever of unknown origin
Fever of unknown origin (FUO) was traditionally characterized by a temperature exceeding 38.3 °C on at least three occasions over a period of at least three weeks, with no apparent cause despite one... more
ACE inhibitors and lung cancer: There is more to it than just a cough
We are writing to highlight the findings of a recent meta-analysis suggesting a possible relationship between the long-term use of angiotensin-converting enzyme inhibitors (ACEIs) and an increased... more
Efficacy of canakinumab for mosaic tumor necrosis factor receptor associated periodic syndrome
Tumor Necrosis Factor Receptor Associated Periodic Syndrome (TRAPS) is one of the first monogenic autoinflammatory diseases to be described [1]. TRAPS is a dominant disease due to mutations in the... more
Longitudinal trends in acute pulmonary embolism hospitalizations during the COVID-19 pandemic
Existing studies have illustrated that the coronavirus disease 2019 (COVID-19) infection is an independent risk factor for pulmonary embolism (PE) [1–4]. However, longitudinal trends in incidence of... more
Histopathological necrotizing vasculitis predicts severe flare of eosinophilic granulomatosis with polyangiitis
Dear Editor, eosinophilic granulomatosis with polyangiitis (EGPA) is histologically defined by eosinophil-rich, necrotizing granulomatous inflammation primarily involving the respiratory tract along... more
Difficult to treat rheumatoid arthritis: Sequential therapy with different personalized biological targets could be an option
Difficult to treat (D2T) rheumatoid arthritis (RA) is considered a clinical setting that physicians already label as very complicated to address from a therapeutic point of view for various reasons [... more
Prognostic value of paradoxical pulsation after acute anterior myocardial infarction
After acute anterior myocardial infarction, most patients displayed paradoxical pulsation (the paradoxical expansion of left ventricular infarct segments), which is easily complicated by early... more
Previously undiagnosed asymptomatic peripheral arterial disease in patients undergoing coronary angiography
Atherosclerosis plays a significant role in developing coronary artery disease (CAD), peripheral artery disease (PAD), and cerebrovascular disease. Atherosclerotic plaque rupture provokes... more
Bone infarction: A rare complication of essential thrombocytosis with JAK2-V617F mutation
We read with great interest the article by Yang et al., published in the European Journal of Internal Medicine [1]. We appreciate their great work. In addition to the finding that JAK2-V617F-mutated... more
Kidney function and sarcopenia: A risk assessment
I read with great interest the paper by Moreno-González et al. [1], who investigated the association between sarcopenia and kidney function in older adults, aged ≥75 years. Estimated glomerular... more
Treatment with direct oral anticoagulants (DOACs) and secondary prophylaxis in patients affected by multiple episodes of superficial venous thrombosis
Superficial vein thrombosis (SVT) describes partial or total thrombotic lumen obstruction of a superficial vein and inflammatory alterations of the affected vessel wall [1]. The precise incidence of... more
Thrombocytopenia and bleeding events in patients with venous thromboembolism
Thrombocytopenia is a prevalent blood abnormality, especially in elderly patients or those with cancer [1], and could increase the risk of anticoagulation-associated bleeding. However, there is a... more
Imaging of lung structure destruction for predictive diagnosing acute exacerbation of chronic obstructive lung disease complicated with pulmonary thromboembolism or pulmonary thrombosis in situ
Chronic obstructive lung disease (COPD) is an independent risk factor for pulmonary thromboembolism (PTE), which often originates from deep vein thrombosis (DVT) and is a common comorbidity [1].... more
Machine learning models for the early prediction of ventilator-associated pneumonia
We read with interest the article by Frondelius et al. entitled ‘Early prediction of ventilator-associated pneumonia with machine learning models: A systematic review and meta-analysis of prediction... more
Combined guidance of fluoroscopy and transthoracic echocardiography for endomyocardial biopsy
Endomyocardial biopsy (EMB) is important in revealing the aetiology of cardiac disorders for individuals in whom non-invasive approaches are insufficient to gather a correct diagnosis, as well as in... more
Don't ignore the internists; Who do you think holds the holy grail?
Recently a new paradigm, cardiovascular-kidney-metabolic (CKM) syndrome, has been defined by the American Heart Association (AHA) as a health problem due to connections among diabetes, kidney disease... more
Original Article
Towards precision medicine in COPD: Targeting type 2 cytokines and alarmins
Chronic obstructive pulmonary disease (COPD) is a main global epidemic increasing as population age and affecting approximately 10% of subjects over 45 years. COPD is a heterogeneous inflammatory... more
Acute kidney injury predicts mortality in very elderly critically-ill patients
The age of patients admitted to intensive care units (ICUs) has witnessed a significant increase in the last decades. Recent statistics reveal that ten to fifteen percent of ICU-admitted patients are... more
Effects of a medical admission unit on in-hospital patient flow and clinical outcomes
In the last decades the epidemiological transition has brought to several acute complex (elderly, frail and poli-pathological) patients that access to Emergency Departments (ED) and require... more
Development and validation of a novel sleep health score in the sleep heart health study
Sleep is closely related to health [1]. Middle-aged and elderly people, especially the elderly, often suffer from sleep disorders, such as sleep apnea and insomnia [2]. These sleep disorders likely... more
Cardiovascular events after exacerbations of chronic obstructive pulmonary disease: Results from the EXAcerbations of COPD and their OutcomeS in CardioVascular diseases study in Italy
Chronic obstructive pulmonary disease (COPD) is a chronic progressive disorder of the lungs with high global morbidity and mortality [1]. The burden and prevalence of COPD are increasing likely due... more
C-reactive protein is more suitable than Serum Amyloid A to monitor crises and attack-free periods in Systemic Auto-Inflammatory Diseases.
Systemic Auto-Inflammatory Diseases (SAID) are diseases with a deregulation of the innate inflammatory response characterized by recurrent fever episodes with systemic inflammation without infectious... more
Hepatic T1-time, cardiac structure and function and cardiovascular outcomes in patients with dilated cardiomyopathy
Liver damage frequently occurs in patients with cardiovascular (CV) disease and predicts worse clinical outcomes [1,2]. In this context, liver damage may be mainly caused by elevated hepatic venous... more
Incidence and predisposing factors of extra-articular manifestations in contemporary rheumatoid arthritis
Rheumatoid arthritis (RA) is the most prevalent of the chronic inflammatory joint diseases, with gradual destruction of joints and an increased risk of co-morbidity, predominantly cardiovascular... more
Consecutive or selectively included high bleeding risk patients in the MASTER DAPT screening log and trial
Screening logs have the potential to appraise the actual prevalence and distribution of predefined patient subsets, avoiding selection biases, which are inevitably and potentially present in... more
Iron deficiency and all-cause mortality after myocardial infarction
Iron is an essential element required for normal mitochondrial function [1,2] oxygen transport, synthesis of proteins and nucleic acids, and normal immune system function. Although iron is... more
Direct oral anticoagulant-associated bleeding complications in patients with gastrointestinal cancer and venous thromboembolism
Venous thromboembolism (VTE), including pulmonary embolism (PE) and deep vein thrombosis (DVT), constitutes the second leading cause of morbidity and mortality in patients with cancer besides the... more
Serum IL-6 level trajectory for predicting the effectiveness and safety of tocilizumab in the treatment of refractory Takayasu arteritis
Takayasu arteritis (TAK) is a chronic systemic granulomatous vasculitis that mainly affects aorta and its major branches in young women [1]. The inflammatory damage of arteries can develop... more
Cardio-protective effects of statins in patients undergoing anthracycline-based chemotherapy: An updated meta-analysis of randomized controlled trials
Cancer and cardiovascular disease are two leading causes of mortality worldwide, and cancer survivors have an increased cardiovascular risk due to shared risk factors with cardiovascular disease and... more
Prognostic value of 18 FDG-PET at diagnosis and follow-up in giant cell arteritis: An observational restrospective study
To evaluate the ability of 18FDG PET/CT, at diagnosis of giant cell arteritis (GCA) and during follow-up, to predict occurrence of relapse in large-vessel GCA (LV-GCA).
Identifying COPD patients with poor health status and low exercise tolerance through the five-repetition sit-to-stand test and modified Medical Research Council Dyspnea Score
Chronic obstructive pulmonary disease (COPD) is a heterogeneous and systemic condition characterized by chronic respiratory symptoms (dyspnea, cough, sputum production) due to abnormalities of the... more
Prognostic impact of hypertension grading
Notwithstanding the continuous relation between blood pressure (BP) and the risk of cardiovascular disease [1,2], Guidelines generally grade hypertension in untreated subjects by arbitrary categories... more
Prognostic value of cognitive impairment, assessed by the Clock Drawing Test, in emergency department patients presenting with non-specific complaints
Cognitive impairment (CI) is common among older patients presenting to the emergency department (ED) [1–6]. Up to 40% of older ED patients have some degree of CI at presentation, particularly due to... more
Clinical significance of the anti-Nucleolar Organizer Region 90 antibodies (NOR90) in systemic sclerosis: Analysis of the European Scleroderma Trials and Research (EUSTAR) cohort and a systematic literature review
The anti-Nucleolar Organizer Region 90 antibodies (NOR90) are rare antinuclear antibodies (ANA) reported in systemic sclerosis (SSc). Especially due to low prevalence, the clinical relevance of NOR90... more
Evolution and outcomes of aortic dilations in giant cell arteritis
Giant cell arteritis (GCA) is a systemic vasculitis that typically affects large and medium vessels in patients over 50 years of age [1–3]. In addition to the cephalic presentation mainly explained... more
Relation of plasma neuropeptide-Y with myocardial function and infarct severity in acute ST-elevation myocardial infarction
Acute myocardial infarction is associated with high levels of cardiac sympathetic stimulation [1], which is strongly related to poor outcome [2]. Prolongation of this sympathetic drive leads to the... more
The interplay between subclinical hypothyroidism and poor sleep quality: A systematic review
Sleep and the hypothalamic-pituitary-thyroid (HPT) axis show a mutual interdependence in normal physiological functioning [1]. While the interconnection between overt hypo- and hyperthyroidism and... more
Serum potassium abnormalities, renin-angiotensin-aldosterone system inhibitor discontinuation, and clinical outcomes in patients with chronic cardiovascular, metabolic, and renal conditions: A population-based analysis
The inhibition of the renin-angiotensin-aldosterone system (RAAS) is a essential aspect of the medical treatment of several chronic cardiovascular, metabolic, and renal conditions. It plays a vital... more
Sex-based differences in the comprehensive geriatric assessment in elderly hospitalized patients with non-valvular atrial fibrillation
Atrial fibrillation (AF) represents the most common supraventricular arrhythmia in elderly [1]. It was estimated that 1 % to 3 % of the world population suffers from AF, with higher prevalence in the... more
The correlation of atherogenic index of plasma with non-obstructive CAD and unfavorable prognosis among patients diagnosed with MINOCA
Myocardial infarction with non-obstructive coronary arteries (MINOCA) is a complex and intriguing phenomenon with diverse underlying pathophysiological mechanisms that challenge conventional... more
Recurrence of hypertriglyceridemia-associated acute pancreatitis: A multicenter, prospective cohort study
Hypertriglyceridemia (HTG) is a well-established etiology of acute pancreatitis (AP), accounting for approximately 4.7–14.3 % of all cases globally [1,2]. Recurrent acute pancreatitis (RAP) is one of... more
Safety and compliance of long-term low-dose ondansetron in alcohol use disorder treatment.
There are geographical differences regarding alcohol-associated morbidity and mortality, the WHO European Region being the most affected area [1]. Europe leads globally in per capita alcohol... more
Visit-to-visit blood pressure variability is associated with intrinsic capacity decline: Results from the MAPT Study
Blood Pressure (BP) values fluctuate over time around average values, as a consequence of the interaction between multiple intrinsic and environmental factors affecting the cardiovascular system [1... more
Early and accurate diagnosis of steatotic liver by artificial intelligence (AI)-supported ultrasonography
Nonalcoholic fatty liver disease (NAFLD) refers to liver steatosis, i.e., over-storage of fat, mainly triglycerides, in the hepatocytes, without other causes for secondary hepatic fat accumulation [1... more
Risk prediction of major cardiac adverse events and all-cause death following covid-19 hospitalization at one year follow-up: The HOPE-2 score
COVID-19 is an infectious disease that has become pandemic from 2020. Data on acute outcome, showed that among hospitalized patients mortality rates were 15.8 % in USA[1] and 22 % in Europe [2,3].... more
Prognosis of COVID-19 severity using DERGA, a novel machine learning algorithm
The Coronavirus Disease 2019 (COVID-19) pandemic, caused by the novel coronavirus Severe Acute Respiratory Syndrome-related Coronavirus-2 (SARS-CoV-2), has had a profound impact on healthcare systems... more
Cardiometabolic risk stratification using a novel obesity phenotyping system based on body adiposity and waist circumference
Over the past decades, obesity has been increasingly prevalent throughout the world. Between 1975 and 2014, the prevalence of obesity in adults, defined as a body mass index (BMI) ≥30 kg/m²,... more
Personalized decision support system for tailoring IgA nephropathy treatment strategies
Immunoglobulin A nephropathy (IgAN), considered the most prevalent form of primary glomerular disease worldwide, is characterized by the deposition of IgA in the mesangial area of the glomeruli and... more
Comparison of diagnostic spectrum between inflammation of unknown origin and fever of unknown origin: A systematic review and meta-analysis
Fever of unknown origin (FUO) and inflammation of unknown origin (IUO) are two clinical syndromes that are separated by an arbitrary temperature threshold. They share a common spectrum of underlying... more
TSLP is localized in and released from human lung macrophages activated by T2-high and T2-low stimuli: relevance in asthma and COPD
The human lung is a remarkable organ that filters up to 10,000 liters of air daily, interfacing with the exposome [1]. Several environmental factors, including airborne pollutants, particulate matter... more
Primary Sjögren's syndrome in Italy: Real-world evidence of a rare disease through administrative healthcare data
Primary Sjögren's syndrome (pSS) is a chronic systemic autoimmune disease with a protean clinical phenotype ranging from very mild manifestations of dry eye and dry mouth to life-threatening major... more
Performance of the Simplified Pulmonary Embolism Severity Index in predicting 30-day mortality after acute pulmonary embolism: Validation from a large-scale cohort
Acute pulmonary embolism (PE) can be life-threatening in certain situations. Recent epidemiological data suggest that PE can affect approximately 300,000 patients and may result in 60,000 to 100,000... more
Impact of early initiation of ezetimibe in patients with acute coronary syndrome: A systematic review and meta-analysis
Patients with acute coronary syndrome (ACS) are at maximal risk of recurrent events in the initial few weeks following the index coronary event, with some studies suggesting that the risk may be as... more
The yield of total body CT in the workup of fever of unknown origin in hospitalized medical patients
A fever of an Unknown Origin (FUO) is defined as a rectal temperature above 38.3 on at least two occasions with an illness duration of over three weeks and no apparent cause after one week of... more
The usefulness of 18F-FDG-PET/CT in detecting musculoskeletal and vascular involvement in patients with polymyalgia rheumatica receiving glucocorticoids
Polymyalgia rheumatica (PMR) is a relatively common disease among European patients older than 50 years [1]. It is an inflammatory disorder characterized by severe pain and stiffness affecting mainly... more
Neurological hypertensive emergencies: Correlation of blood pressure values with in-hospital outcomes in ischemic stroke
Few certainties exist regarding optimal management of Blood Pressure (BP) in the very first hours after an ischemic stroke and many questions remain still unanswered. Our work aimed to evaluate the... more
Osteonecrosis risk after steroids-related treatment of COVID-19 is not negligible: A cross sectional study
Osteonecrosis is a common complication after steroid treatment for various etiologies more frequently affecting the hip, but also the humeral head, the knee, and the ankle joints [1]. Due to the... more
Transition of management strategies and long-term outcomes in cancer-associated venous thromboembolism from the warfarin era to the direct oral anticoagulant era
Cancer remains a progressive disease with a high mortality despite of multidisciplinary treatment. However, many patients with cancer have recently been living longer owing to advancement in early... more
Post-cardiac injury syndrome and pericardial effusion recurrence after pericardial effusion drainage in chronic idiopathic pericardial effusion
Chronic pericardial effusion in the absence of pericardial inflammation often represents both a diagnostic and management dilemma. Although pericardial effusion drainage should be promptly performed... more
Genetic heterogeneity of familial hypercholesterolaemia in two populations from two different countries
Familial hypercholesterolemia (FH) (MONDO:0007750) is a genetically determined monogenic disorder of predominantly autosomal dominant inheritance, which leads to a significant increase in low-density... more
A systematic literature review of randomised controlled trials evaluating colchicine for cardiovascular prevention: There is an elephant in the room
Gout is a chronic inflammatory disease burdened by a higher CV risk compared to the general population [1] and this excess risk cannot be explained only by the prevalence of traditional risk factors... more
Deferring diagnostic evaluation for suspected deep venous thrombosis using a single dose of anticoagulant: Real-world data from a regionwide care pathway
Timely diagnosis and treatment of deep venous thrombosis (DVT) are crucial to prevent potential life-threatening complications, such as pulmonary embolism (PE). As DVT cannot be reliably excluded... more
Intimate partner violence as a risk factor for venous thromboembolism in women on combined oral contraceptives: An international matched case-control study
Venous thromboembolism (VTE), deep vein thrombosis (DVT) and/or pulmonary embolism (PE) is a rare event in women of childbearing age, affecting 2–10/10,000 persons per year [1]. Exogenous sex... more
Thyroid and adrenal incidentalomas on chest CT: Prevalence, diagnostic work-up and outcomes in a cohort of COVID-19 suspected patients
Thyroid and adrenal incidentalomas are commonly detected on computed tomography (CT) imaging. Due to the increased use of advanced CT imaging prevalence rates are still rising, leading to an ‘... more
Adherence to an integrated care pathway for stroke is associated with lower risk of major cardiovascular events: A report from the Athens Stroke Registry
Despite improvements in overall stroke survival, patients surviving an ischaemic stroke are at increased risk of cardiovascular complications, both in the acute and chronic phase, and one-third of... more
Kidney function and other associated factors of sarcopenia in community-dwelling older adults: The SCOPE study
Sarcopenia has been drawing growing attention in recent years, with a rapidly increasing number of research studies being performed in this field. The establishment of an International Classification... more
Features of immune mediated diseases in JAK2 (V617F)-positive myeloproliferative neoplasms and the potential therapeutic role of JAK inhibitors
The Janus Kinase (JAK) 2 (V617F) mutation is the most frequently detected in myeloproliferative neoplasms (MPN). JAK2(V617F) mutation displays a pro-inflammatory phenotype that may be associated to a... more
Chronic thromboembolic pulmonary disease: Association with exercise-induced pulmonary hypertension and right ventricle adaptation over time
Chronic thromboembolic pulmonary disease (CTEPD) [1] is a newly described disease entity belonging to a broader group of diseases affecting the pulmonary arterial vasculature as a result of PE [1,2... more
Relation between high-sensitivity troponin I serum levels and myocardial ischemia in patients with suspected chronic coronary syndrome: The RESET-MI study
The detection of increased serum levels of cardiac troponins in a clinical context of acute myocardial ischemia is a crucial finding for the diagnosis of acute myocardial infarction (AMI) [1,2].... more
Muscularity and adiposity are differently associated with inflammatory and nutritional biomarkers among patients on hemodialysis and peritoneal dialysis
Changes in body composition, in particular in terms of distribution and quantity of adiposity and low muscularity, have been frequently observed in end-stage renal disease (ESRD) and associated with... more
Long non-coding RNAs H19 and NKILA are associated with the risk of death and lacunar stroke in the elderly population
Aging is a multifaceted biological process characterized by a progressive decline in physiological function and increased vulnerability to various diseases [1]. It is associated with multiple... more
Prognostic role of mitral regurgitation in patients with advanced heart failure
Mitral regurgitation (MR) is the most common valvular heart disease in patients with heart failure (HF) [1]. Left ventricular remodeling, left atrial enlargement, and cardiac dyssynchrony leading to... more
Risk of subclinical atherosclerosis in primary Sjogren's syndrome: A systematic review and meta-analysis
Cardiovascular disease (CVD) in systemic autoimmune disorders often goes unnoticed until a clinical event occurs. Given the lack of disease-specific prediction scores, the CVD risk stratification... more
Calprotectin serum levels on admission and during follow-up predict severity and outcome of patients with COVID-19: A prospective study
Coronavirus disease-2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is characterized by a broad spectrum of clinical manifestations [1]. SARS-CoV-2... more
Prognostic significance of the wall to lumen ratio of retinal arterioles evaluated by adaptive optics
The main characteristic of essential hypertension is the increase in peripheral vascular resistance to blood flow, located mostly in small arteries with a lumen diameter of 100 to 350 μm and in... more
ECG/echo indexes in the diagnostic approach to amyloid cardiomyopathy: A head-to-head comparison from the AC-TIVE study
Thickened left ventricle (LV) is the hallmark of amyloid cardiomyopathy (AC) and results from progressive amyloid deposition in the myocardial extracellular space rather than myocyte hypertrophy [1... more
Review Article
Single-pill combination for treatment of hypertension: Just a matter of practicality or is there a real clinical benefit?
Cardiovascular disease (CVD) represents the leading cause of morbidity and mortality worldwide resulting in approximately one third of all deaths globally [1,2]. Despite significant advances in... more
Type 1 diabetes-related distress: Current implications in care
Type 1 diabetes (T1D) is a complex and demanding chronic disease characterized by a severe lack of insulin synthesis which needs to be supplied exogenously [1,2]. In this context, people living with... more
Metabolic Bariatric surgery in People with Obesity aged ≥65 Years
The World Health Organization (WHO) estimated that 1.4 billion people in the world will be aged 60 years and older in 2030 and 2.1 billion by 2050, comprising 12–22 % of the global population [1].... more
Gender-specific insights into the irritable bowel syndrome pathophysiology. Focus on gut dysbiosis and permeability
Irritable bowel syndrome (IBS), a chronic functional gastrointestinal disorder, manifests through recurrent episodes of abdominal pain or discomfort, coupled with variations in bowel habits... more
The complement system in the pathogenesis and progression of kidney diseases: What doesn't kill you makes you older
The Complement System is an evolutionarily conserved component of immunity that plays a key role in host defense against infections and tissue homeostasis. However, the dysfunction of the Complement... more
Challenges of antimicrobial stewardship among older adults
Antimicrobial resistance is a global public health concern that threatens our ability to treat bacterial infections successfully [1]. Whereas antimicrobial optimization in the hospital was reported... more
Treatment in primary biliary cholangitis: Beyond ursodeoxycholic acid
Primary biliary cholangitis (PBC), which was formerly called primary biliary cirrhosis, is a rare chronic immune-mediated liver disease [1,2]. A recent meta-analysis indicated that the pooled global... more
Dietary and pharmacological treatment in patients with metabolic-dysfunction associated steatotic liver disease
Metabolic-dysfunction Associated Steatotic Liver Disease (MASLD), previously known as Non-Alcoholic Fatty Liver Disease, is a spectrum of liver injury characterized by increased hepatocellular fat... more
Non-invasive testing and risk-stratification in patients with MASLD
The development and validation of non-invasive fibrosis tests (NITs) has changed clinical practice in Hepatology over the last 15 years. Metabolic associated steatotic liver disease (MASLD), formerly... more
The impact of colchicine on patients with acute and chronic coronary artery disease
Inflammation is a major contributor in the development and progression of coronary artery disease (CAD). Preclinical studies have demonstrated that inflammatory processes, by means of specific... more
Resistant hypertension: Diagnosis, evaluation, and treatment practical approach
Our learning objectives are to be able to identify patients with resistant hypertension (RH) in primary care practice, know the clinical and phenotypic characteristics of this group of patients, and... more
Breakthrough advances enhancing care in ATTR amyloid cardiomyopathy
Transthyretin amyloid cardiomyopathy (ATTR-CM) has been traditionally considered a rare and inexorably fatal condition. ATTR-CM now is an increasingly recognized cause of heart failure (HF) and... more
Enduring echoes: Post-infectious long-term changes in innate immunity
The human immune system is one of the main host defence mechanism against infections, initiating a complex response when confronted with pathogenic invaders. This response involves pathogen... more
Natural history of metabolic dysfunction-associated steatotic liver disease
Metabolic dysfunction-associated steatotic liver disease (MASLD) has been the term for non-alcoholic fatty liver disease (NAFLD) since June 2023 and will be used instead of NAFLD throughout this... more